Features and outcomes of hypertrophic cardiomyopathy complicated by cardiogenic shock: an analysis of the FRENSHOCK multicenter prospective registry.

Abstract

Background: Cardiogenic shock (CS) in patients with left ventricular hypertrophy (LVH) due to hypertrophic cardiomyopathy (HCM) or hypertensive heart disease, is underreported in the literature. This study aimed to delineate the characteristics, management strategies and outcomes of patients experiencing CS with preexisting LVH and HCM.

Methods: FRENSHOCK is a prospective multicenter registry including 772 unselected CS patients from 49 centers. Baseline characteristics, management and 1-year outcomes were analyzed according to the occurrence on preexisting LVH.

Results: Within 772 CS patients included, CS occur on a preexisting LVH in 34 patients (4.4%, 1.4% with HCM). Clinical characteristics, medical history, and usual medications, as well as hemodynamic parameters upon inclusion, did not differ between patients with or without LVH. The LVEF in CS patients with LVH was 27.3 ± 14.5% indicating a non-obstructive cause of CS. In-hospital management according to LVH and non-LVH groups indicated no differences between the groups. The 1-month and 1-year mortality did not differ between CS patients with and without LVH (respectively 26.5% vs 26%, (adjusted HR [95% CI]: 0.87 [0.44-1.72]) and 55.9% vs 44.7%, (adjusted HR [95% CI]:0.88 [0.54-1.42]). Subgroup analyses comparing HCM (n =11) and hypertensive LVH (n=23) revealed similar clinical characteristics, in-hospital management, and one-year rehospitalization rates for these patients.

Conclusion: In a large and unselected CS population, the prevalence of LVH patients is low (4.4%) with less than half having HCM (1.4%). The presentation, management, and outcomes of CS are similar to the broader CS population in our series. However, HCM-CS represents a distinct clinical entity necessitating tailored management approaches.